Claims Adjuster II - Workers' Compensation

Brotherhood Mutual Careers•Fort Wayne, IN

7d•Onsite

About The Position

Responsible for effectively analyzing and resolving assigned claims consistent with Claims Department standards and company objectives. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Resolve all assigned claims (including the occasional serious/complex claim, which could include but not be limited to unusual damage or coverage issues, or that need the involvement of expert analysis or require early recognition of policyholder concerns) within established settlement authority in a prompt, fair and equitable manner. Identify and investigate coverage, damage, and reserve adequacy on assigned claims. Apply statutes, common law, and other applicable legal and regulatory concepts for the effective, efficient and equitable resolution of assigned claims. Achieve established claim file audit objectives. Communicate with policyholders, agents, claimants, attorneys, medical providers and other persons as needed and direct independent adjusters, appraisers and other support service providers to ensure effective, efficient, and equitable claims resolution. Acquire, record and maintain all essential file documentation in accordance with established guidelines. Provide timely status reports regarding assigned claims to claims department management and others. Identify and pursue appropriate cost containment, loss mitigation and subrogation recovery opportunities. Participate and provide input in departmental meetings or interdepartmental meetings, projects or processes that relate to the claims function. Travel as needed to attend training programs, conferences, mediation/other legal proceedings, and to conduct investigation relating to claims resolution. Further the attainment of overall department objectives by assisting other claims personnel as needed. Participate as needed in the orientation or training of new department personnel. Complete other projects as assigned.

Requirements

Must be able to effectively communicate with others (both oral and written).
Must demonstrate the ability to present a reasoned position in both an oral and written format.
Must be able to make independent decisions.
Must have good interpersonal skills.
Must have the ability to handle confrontational situations in a productive manner.
Must demonstrate the ability to employ sound negotiation techniques in the resolution of assigned claims.
Must have good organizational skills.
Must have a good understanding of basic issues related to claims.
Must have a good understanding of coverage issues.
Must be able to access, input and retrieve information from a computer.
Must have a good understanding of all automated claims department processing systems and workflows.
Should be able to sit for prolonged periods of time.
Possess the ability to inspect losses by walking, lifting, climbing or bending.
Effectively interface with external contacts, Brotherhood employees, managers, and department staff members.
Bachelor’s degree or completed AIC or completed 3 parts of CPCU, is required.
Must be able to take and pass mandatory adjuster licensing requirements.
Must have 3 years or more of claim technical experience.

Nice To Haves

AIC/CPCU or other insurance-related course work is desired.
5 years or more of Brotherhood Mutual claims technical experience is desired.
Persons in this position must be familiar with church operations and must conduct themselves in a manner that will neither alienate nor offend persons within this target niche.

Responsibilities

Resolve all assigned claims (including the occasional serious/complex claim, which could include but not be limited to unusual damage or coverage issues, or that need the involvement of expert analysis or require early recognition of policyholder concerns) within established settlement authority in a prompt, fair and equitable manner.
Identify and investigate coverage, damage, and reserve adequacy on assigned claims.
Apply statutes, common law, and other applicable legal and regulatory concepts for the effective, efficient and equitable resolution of assigned claims.
Achieve established claim file audit objectives.
Communicate with policyholders, agents, claimants, attorneys, medical providers and other persons as needed and direct independent adjusters, appraisers and other support service providers to ensure effective, efficient, and equitable claims resolution.
Acquire, record and maintain all essential file documentation in accordance with established guidelines.
Provide timely status reports regarding assigned claims to claims department management and others.
Identify and pursue appropriate cost containment, loss mitigation and subrogation recovery opportunities.
Participate and provide input in departmental meetings or interdepartmental meetings, projects or processes that relate to the claims function.
Travel as needed to attend training programs, conferences, mediation/other legal proceedings, and to conduct investigation relating to claims resolution.
Further the attainment of overall department objectives by assisting other claims personnel as needed.
Participate as needed in the orientation or training of new department personnel.
Complete other projects as assigned.